As death changes form, we must change strategies

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heart disease ticking time bomb

Adjunct Professor John G Kelly, AM

Group CEO, National Heart Foundation of Australia
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John joined the Heart Foundation in August 2016. Previous to that, he led sector reform for aged care as CEO of Aged and Community Services Australia. He has extensive clinical, management and consulting background in the health sector, including previous careers in law and in cardiac nursing and current academic appointments with the Sydney Nursing School and the University of Technology, Sydney.

You can tell a lot about a nation from how its people die. Until early last century, Australians died mainly of infectious diseases.  Today we are far more likely to succumb to ones you can’t catch from other people or animals: heart disease, diabetes, cancer, chronic lung diseases.

This speaks partly to the huge gains made in eradicating or curtailing killers such as smallpox and malaria, and partly to the massive shifts in lifestyle and longevity that have accompanied these gains.

Today, our main risks are not invisible pathogens but factors such as poor diet, smoking, alcohol use and lack of exercise, which kill more than 40 million people each year worldwide and leave millions sick, sometimes permanently disabled.

More people now die each year globally of non-communicable diseases (NCDs) than of infections.

In September, health groups from around the world gathered in New York for the third UN High-Level Meeting on Noncommunicable Diseases. They hoped the summit would spur a huge international effort to hold big business to account and tackle head-on the devastating effects of NCDs. Instead, a statement by more than 300 organisations, led by the global NCD Alliance, bluntly accused governments of having failed their citizens and having squandered a chance to provide political leadership and hard cash that would save millions of lives. Governments, it said, were sleepwalking into a sick future.

Australia is not immune. 

Nine in 10 of us dies from a chronic illness. Cardiovascular disease (including heart disease and stroke) affects more than four million of us, costs close to $9 billion each year and accounts for almost 30 per cent of all deaths.

This is not to diminish our achievements. We’ve come a long way from the 1960s when nearly six in 10 died from cardiovascular disease.

But the great gains of recent decades may now be at risk. As a nation we’re getting older and more overweight, and most of us still don’t do enough exercise – all major risk factors for cardiovascular disease.

Already there are warning signs. The rate of decline in cardiovascular disease among younger Australians (35­–54 years) is starting to slow.

Instead of congratulating ourselves for past successes, we need to redouble our efforts. The remedies are well tested, affordable and in some cases (such as taxes on alcohol and sugary soft drinks) would save millions of dollars.

So what next? The Federal Government’s recently announced funding for the development of a National Heart and Stroke Action Plan is a good start. The challenge now will be for all state and federal governments to embrace its recommendations and implement the plan in partnership with the Heart Foundation and Stroke Foundation. We need to prevent problems before they arise – to encourage people to walk more, drink less and quit smoking; to encourage those 45 years and older (35 for Indigenous Australians) to access vital heart health checks through their GPs. When people do have heart attacks or strokes, we need to treat them quicker and then get them the rehabilitation they need afterwards.

Consider this: six years ago, less than half of eligible New Zealanders had had a heart check within the past five years. Today, after a concerted campaign by our NZ colleagues, that figure is around 90 per cent.

It just takes the will.